Kajang Hospital

Road safety education (RSE) is a vital component of primary school curricula to instil safe road behaviours early. However, traditional classroom-based approaches such as Pendidikan Keselamatan Jalan Raya (PKJR) may lack engagement and developmental appropriateness. This study implemented and evaluated the R-Safe Race, a play-based RSE programme designed for Malaysian primary school children aged 10–12, following the ADDIE instructional design model. The programme was conducted as an outdoor exploration race featuring six thematic checkpoints addressing key road safety topics. A total of 164 students participated, and their perceptions of content clarity, relevance, interest, understanding, and learning gains were assessed through a structured questionnaire using a 5-point Likert scale. Findings showed strong engagement and positive perceptions overall, with particularly high ratings for checkpoints on car passengers and cyclist behaviour. Participants reported increased self-efficacy to adopt safer behaviours and found the facilitators effective. However, lower ratings on the transportation and vehicle safety checkpoints suggest areas for improvement. The results support play-based learning as an effective pedagogical approach to enhance engagement, understanding, and self-regulation in RSE. This study highlights the need to diversify RSE delivery methods to align with children’s developmental needs, suggesting that outdoor, guided play activities offer significant benefits over traditional approaches.

The authors of this retrospective study evaluated the long-term surgical outcomes and complications of microvascular decompression (MVD) for glossopharyngeal neuralgia (GPN) using the combined transcondylar fossa (trans-CF) and unilateral transcerebellomedullary fissure (trans-CMF) approach. All patients with idiopathic GPN treated via MVD at the authors' institution from 2003 to 2019 were considered for study inclusion. The combined trans-CF and unilateral trans-CMF approach was utilized with particular attention to securing the offending vessel(s) to the dura mater to prevent recurrence. Surgical outcomes were evaluated using the Barrow Neurological Institute (BNI) pain intensity scale. Of the 23 patients treated with MVD via the combined trans-CF and unilateral trans-CMF approach in the study period, 21 (14 females [66.7%] and 7 males [33.3%], mean age 60.6 years) were followed up for more than 5 years (mean 149.9 months, range 63-235 months). Twenty (95.2%) of the 21 patients reported immediate pain relief (BNI pain score I), and only one required reoperation for recurrent pain. At the final follow-up, the 20 patients without reoperation reported complete pain relief and no increase in their BNI pain score (indicating greater pain). Seven patients (33.3%) experienced transient mild dysphagia or hoarseness postsurgery, but there were no permanent complications. MVD for GPN using the combined trans-CF and unilateral trans-CMF approach achieved excellent outcomes with few complications. This technique offers several advantages: 1) wider exposure of the lower cerebellopontine angle, 2) reduced cerebellar retraction, 3) improved visualization for transposition of offending vessels, particularly a high-origin posterior inferior cerebellar artery, and 4) minimal manipulation of the lower cranial nerves. The selection of a suitable approach based on careful preoperative imaging and appropriate vessel transposition techniques is essential for achieving favorable long-term outcomes.

Elderly patients often face high risks of chronic diseases such as heart conditions, and improving clinical decision support for their care is a priority. This paper presents a comprehensive review and empirical study of machine learning-driven decision support systems for elderly healthcare, leveraging the MIMIC-III and MIMIC-IV critical care datasets. We examine data preprocessing strategies such as handling missing values via imputation and normalization, feature engineering techniques including domain-specific feature creation and dimensionality reduction, and Machine Learning (ML) models for heart disease risk prediction with an emphasis on ensemble methods such as Random Forests and XGBoost (Extreme Gradient Boosting). We also explore medication recommendation systems powered by ML and discuss approaches to integrating predictive models into user-friendly healthcare dashboards. Our experiments focus on predicting heart disease-related outcomes in patients aged 60 and above using Random Forest and XGBoost, showing that both models achieve strong predictive performance, with XGBoost outperforming Random Forest in terms of AUC. We integrate these findings with the existing literature, highlighting challenges such as data quality, interpretability, and ethical considerations. The results demonstrate the potential of ML, especially tree-based ensembles, to enhance decision support for elderly care, while emphasizing the significance of robust data preprocessing and the need for interpretable and clinically integrated solutions. We conclude with discussions on future research directions, including addressing bias in models, ensuring generalizability, and improving clinician adoption of AI-driven tools.

Peripartum cardiomyopathy is a rare cause of heart failure that affects a woman in her late pregnancy or within the early months of the postpartum period. The failure symptoms can develop gradually or in an acute state if precipitated by other uncontrolled medical conditions commonly hypertension. This case report illustrated a woman in her 30s at 14 weeks 4 days period of gestation, who presented to the hospital with worsened heart failure symptoms. She was categorized as a high-risk pregnancy and thus proceeded with termination of pregnancy (TOP) due to maternal reasons. The case report highlights important discussions regarding the legal aspects of TOP in Malaysia and available options for high-risk women to have children through adoption or surrogacy.

This study aims to examine the relevance of classical Islamic legal categories in defining the status of non-Muslims within the context of Indonesia’s pluralistic and democratic state. The research is motivated by recent debates surrounding the use of the term kāfir ("infidel") and the need to reassess traditional terminologies such as ahl al-dhimmah, ahl al-ḥarb, al-muʿāhid, and al-mustaʾmin in light of contemporary constitutional values. Using a qualitative approach within a library-based research design, the study analyzes classical fiqh texts and Indonesian constitutional and statutory legal documents. Through thematic content analysis, the study evaluates the compatibility of Islamic legal reasoning with modern legal principles. The findings indicate that classical classifications of non-Muslims were shaped by the political and imperial contexts of premodern Islamic governance. These categories are no longer fully applicable in the Indonesian nation-state, which is based on equality before the law and religious pluralism. In contrast, the concept of al-muwāṭinūn (citizens) aligns with the Islamic legal principle of murūnah (adaptability) and supports ijtihād (juridical reasoning) responsive to contemporary societal needs. The study contributes practically by offering a theologically grounded yet constitutionally relevant vocabulary for citizenship that enhances civic inclusion and legal equality. It demonstrates how Islamic jurisprudence can evolve to support pluralistic nationhood. This research provides an original contribution by contextualizing classical fiqh within Indonesia’s constitutional framework, an area underexplored in existing literature. By bridging Islamic legal ethics and Indonesian law, it offers a normative model for redefining non-Muslim citizenship in Muslim-majority democracies.

ABSTRACTBackgroundAdministering intravenous (IV) drugs carries a high risk of adverse effects due to their direct entry into circulation. Identifying the prevalence and types of IV administration errors and the drugs involved is crucial for implementing effective interventions to reduce such errors.AimThis systematic review aimed to examine and synthesise the available articles on medication errors involving IV administration in hospitalised patients.MethodsA comprehensive search was conducted using electronic databases, including PubMed, Ovid Medline, and CINAHL. The search was performed without time limitation up to July 2023. However, only articles published in English and human subjects were included. The quality of the studies was appraised using the Newcastle‐Ottawa quality assessment scale (NOS). This systematic review was registered with PROSPERO (CRD42023469352).ResultDatabase searches yielded 2177 articles; after duplicate removal, 1717 underwent title and abstract screening, and 23 were included after full‐text review. The studies were from 12 countries, and the multicentre study included countries from Europe, Africa, the Americas, Asia, and Australia. The majority of the studies were conducted in either teaching hospitals (n = 11) or university‐affiliated hospitals (n = 7), with most involving direct observation (n = 21). IV administration errors exhibit a broad prevalence range of 5.0%−62.9%, involving various types such as wrong diluent, dose, route, rate, technique, omission, and timing. Studies lack uniformity in reporting, with some not specifying prevalence. The highest prevalence of specific errors varies across settings.ConclusionOur review highlights that IV medication error rates vary based on study design, setting, and population. Standardised definitions, reporting procedures, and reliable tracking methods are needed. Human factors, system issues, and environmental stressors influence medication errors. Future research must improve our understanding and address these factors to enhance patient safety and healthcare quality.

ObjectivesThis study quantified the health and economic benefits of improving low-density lipoprotein cholesterol (LDL-C) control in Malaysian patients with established atherosclerotic cardiovascular disease (ASCVD). It aimed to inform policy discussions and healthcare planning for effective ASCVD management. MethodsA deterministic, prevalence-based model was used to project the annual health burden and direct medical costs associated with recurrent ASCVD events over a 10-year horizon. The target population included adults (≥30 years) with established ASCVD and uncontrolled LDL-C levels (>1.8 mmol/L). The model comprised 3 modules: population size projection, recurrent ASCVD risk calculation (by means of the Secondary Manifestations of ARTerial disease [SMART] risk model), and direct medical and productivity cost estimation. The current status quo and a scenario with a 50% improvement in mean LDL-C were compared. ResultsWe projected over 800 000 adults with established ASCVD in 2023, increasing to approximately 1.4 million by 2032. Under the status quo, about 55 000 recurrent ASCVD events were expected within 10 years, with significant direct medical costs and productivity losses. Improved LDL-C control could potentially reduce recurrent events by 7000 cases (13% reduction), prevent 2100 premature deaths, and save approximately 32 400 years of life. Economically, this could lead to a reduction of approximately 72 million MYR in direct medical costs and a gain of approximately 132.4 million MYR in productivity over a decade. ConclusionsOptimizing LDL-C control in high-risk patients with ASCVD presents a critical opportunity to reduce health and economic burdens in Malaysia.

Anticoagulant-related nephropathy (ARN) is a rare type of acute kidney injury (AKI) caused by excessive anticoagulation with warfarin or other anticoagulants, such as direct oral anticoagulants (DOACs). We describe a case of a woman in her 50s with a background history of mitral valve replacement who was on warfarin and admitted for AKI, haematuria and a supratherapeutic international normalised ratio (INR) level. A renal biopsy showed red cell casts in the renal tubules, and a diagnosis of ARN was made. Her treatment included the temporary withdrawal of warfarin. Her renal function improved, and warfarin was restarted before she was discharged. This case highlights the importance of maintaining a high clinical suspicion when diagnosing ARN in patients who present with AKI and supratherapeutic INR levels.

Abstract In December 2006 until January 2007, the Northeast Monsoon had contributed to heavy rain through a series of continuous extreme storms that caused a disastrous flood for several areas of Malaysia. This study aimed at Batu Pahat, Johor catchment areas that are heavily impacted due to the low-lying catchment area. The stagnant flooding that occurred during the 2006/2007 flood event had caused huge losses towards the residents, properties and the environment. This paper aims to determine the hydraulic and hydrologic characteristics of low-lying areas in Batu Pahat catchment. ICM Infoworks software is used to develop flood modeling for the study area. The contribution of this study is to develop the flood mapping of 2006/2007 flood events for 20-years, 50-years, and 100-years ARI. Based on the modeling results, detention ponds and pumping systems are proposed to mitigate the flood resulting in a 44.47% reduction of affected area for 50 years ARI rainfall event. This study concludes that detention ponds and pumping systems can be used as a reliable solution to reduce the impact of floods on the study area.